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诊所合作伙伴
首页
关于我们
年度股东大会的会议记录
新闻
我中心新闻
视频
每周医院的视频博客
服务介绍
乌克兰代孕咨询
代孕程序的概述说明
BioTexCom 在国际大众媒体上
我们的团队
图库
我们的医疗中心
3D游览
我们新的产科医院
我们的孩子
我们的孩子 (视频)
住房为我们的客户
BioTexCom 和运动 : 我们支持那些谁相信梦想
捐献者
联系我们
在线申请
Apply online
诊所合作伙伴
Apply online
Home
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Application form for customer program
Name:
City:
Nationality:
Male:
Female:
Age:
Male:
Female:
Occupation:
Male:
Female:
Are You married?
How long?
Infertility causes and diagnosis:
When do You want to enter the surrogacy program?
Date:
Your own eggs or donor's eggs?
Own
Egg donation
Is it important for You to choose gender?
Yes
No
What kind of package do you want?
Standard
VIP
Your contact information:
Email:
QQ:
Weixin:
Phone number:
How did You find us?
Do You want to discuss future cooperation with us?
Your additional information:
In order to obtain quick consultation and the hospital direct service manager program, please provide the required information ( JPG, PNG, BMP, PDF, the size can't exceed 1Mb).
Infertility certificate:
Choose file
No file chosen
Passport:
Choose file
No file chosen
Marriage certificate:
Choose file
No file chosen
Syphilis:
Choose file
No file chosen
Hepatitis E:
Choose file
No file chosen
Karyotype:
Choose file
No file chosen
AIDS:
Choose file
No file chosen
Mammography:
Choose file
No file chosen
Breast ultrasound:
Choose file
No file chosen
Vaginal ultrasound:
Choose file
No file chosen
Uterus ultrasound:
Choose file
No file chosen
AMH anti-Mug hormone:
Choose file
No file chosen
E2, LH, FSH, PROG. PRL
Choose file
No file chosen
Sperm fluid analysis report:
Choose file
No file chosen
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